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Randomized Controlled Trial
. 2022 Aug 1;106(8):1677-1689.
doi: 10.1097/TP.0000000000004072. Epub 2022 Jul 22.

Hemodynamic Effects of High-dose Levothyroxine and Methylprednisolone in Brain-dead Potential Organ Donors

Adrian B Van Bakel  1 , Sheryl A Hino  2 , Darla Welker  2 , Kristen Morella  3 , Mathew J Gregoski  3 , Michael L Craig  1 , Arthur J Crumbley  4 , Robert M Sade  4
Affiliations
Randomized Controlled Trial

Hemodynamic Effects of High-dose Levothyroxine and Methylprednisolone in Brain-dead Potential Organ Donors

Adrian B Van Bakel et al. Transplantation. .

Abstract

Background: Hormonal replacement therapy is administered to many brain-dead organ donors to improve hemodynamic stability. Previous clinical studies present conflicting results with several randomized studies reporting no benefit.

Methods: Consecutive adult donors (N = 199) were randomized to receive high-dose levothyroxine, high-dose methylprednisolone, both (Combo), or no hormonal therapy (Control). Vasopressor requirements using the vasoactive-inotropic score (VIS) were assessed at baseline, 4 h, and at procurement. Crossover to the Combo group was sufficient to require separate intention-to-treat and per-protocol analyses.

Results: In the intention-to-treat analysis, the mean (±SD) reduction in VIS from baseline to procurement was 1.6 ± 2.6, 14.9 ± 2.6, 10.9 ± 2.6, and 7.1 ± 2.6 for the levothyroxine, methylprednisolone, Combo, and Control groups, respectively. While controlling for the baseline score, the reduction in VIS was significantly greater in the methylprednisolone and Combo groups and significantly less in the levothyroxine group compared with controls. Results were similar in the per-protocol analysis.

Conclusions: High-dose methylprednisolone alone or in combination with levothyroxine allowed for significant reduction in vasopressor support in organ donors. Levothyroxine alone offered no advantage in reducing vasopressor support. Organ yield, transplantation rates, and recipient outcomes were not adversely affected.

Trial registration: ClinicalTrials.gov NCT04528797.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

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